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HELLP syndrome

HELLP syndrome is a life-threatening complication of pre-eclampsia. Both conditions occur during the latter stages of pregnancy, or sometimes after childbirth. more...

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HELLP is an abbreviation of the main findings:

  • Hemolytic anemia
  • Elevated Liver enzymes and
  • Low Platelet count

Signs and symptoms

Often, a patient who develops HELLP syndrome has already been followed up for gestational hypertension, or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases present after delivery.

There is gradual but marked onset of headaches (30%), blurred vision, malaise (90%), nausea/vomiting (30%), "band pain" around the upper abdomen (65%) and tingling in the extremities. Oedema may occur but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur. If the patient gets a seizure or coma, the condition has progressed into full-blown eclampsia.

Diagnosis

In a patient with possible HELLP syndrome, a batch of blood tests is performed: a full blood count, liver enzymes, renal function and electrolytes and coagulation studies. Often, fibrin degradation products (FDPs) are determined, which can be elevated. Lactate dehydrogenase is a marker of hemolysis and is elevated (>600 U/liter). Proteinuria is present but can be mild.

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Preeclampsia presentation varies depending on race and ethnicity
From OB/GYN News, 3/15/05 by Robert Finn

RENO, NEV. -- A retrospective study examining 473 pregnancies complicated by preeclampsia has uncovered a number of significant racial and ethnic differences in the expression of the disorder.

African American women with preeclampsia tend to have more severe hypertension and more often require antihypertensive medication than the population at large, according to a poster presentation by Amy Goodwin, M.D., of Case Western Reserve University, Cleveland, and associates at the annual meeting of the Society for Maternal-Fetal Medicine.

While 37% of the full sample had severe hypertension at diagnosis, 45% of African American women had severe hypertension. African American women were also significantly more likely to require antihypertensive medication intrapartum (12% vs. 8.8%), post partum (18% vs. 13%), and at discharge (35% vs. 27%).

Non-Hispanic Caucasian women more frequently manifest severe hypertension with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. While 24% of the full sample exhibited HELLP, the rate among Caucasian women was 30%.

Hispanic women tend to present with preeclampsia later in gestation and with less severe disease than the rest of the population. They presented at a mean of 36 weeks of gestation vs. 34.4 weeks for the rest of the population, and a smaller proportion of them exhibited severe hypertension at diagnosis (27% vs. 37%).

The study found no significant differences by race or ethnicity in a number of other factors including proteinuria, eclampsia, intrauterine fetal distress, intrauterine growth retardation, abruption, and recurrent preeclampsia.

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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